'My best friends are gay, and they are getting married. I believe that if two people love each other, who am I to say they shouldn't be happy? from what I can tell, cMf opposes gay marriage, so I need to resign my membership.'

I occasionally get emails like this from CMF students, on issues from abortion to sexuality to end of life care. You might wonder what this has to do with 'worldview', the theme of this issue. I would say: 'everything', and I'm going to explain why. In this first worldview article, we are focusing on the importance of understanding our worldview, before moving on to look at elephants in the second (yes, seriously).

What is a worldview?

A worldview is a set of beliefs and assumptions that a person uses when interpreting the world around them. Many of you will recognise the triangle: worldview (bottom), then beliefs, then values then behaviour at the tip of the triangle. I confess I can get fed up debating the tip of the iceberg — behaviour, values or beliefs (perhaps like some of the emails in my inbox) — because they are driven by a worldview, something much deeper. this is why we are dealing with worldview first in our refreshed Nucleus. If you don't grasp this now, you will go through medical school, and life, dealing with surface issues. Unless your foundations are firm, when your worldview is challenged on the wards and in clinics, you will find yourself struggling.

Universal questions

We can't escape this fundamental truth: every human being has to answer key questions. Take a look at the worldview grid to see some of the key questions and answers given by a selection of mainstream worldviews.

Everyone has a story

I like to think of worldviews as stories. Our lives and culture are shot through with stories that cover these questions. Most films follow suit (see our new culture section starting on page 34). In fact, I would argue that major worldviews are often based on stories rather than claimed 'facts'. A scientific naturalist might offer the explanations as in the table. And yet, I often hear a story running through that goes a bit like this:
'Once upon a time, we believed in spirits and fairies and gods and demons. But as we became rational, and especially as we marshalled naturalistic explanations for what we used to attribute to spirits and forces, the world became progressively disenchanted. Now we are free — and it is an exhilarating feeling. I am not constrained — granted the universe may not comfort me, but at least it doesn't demand anything of me. I get to decide what I pursue — God is dead, vive la revolution.' (1)

This is a testimony of conversion from an 'immature, Sunday-school faith' to new faith, 'a faith in science's ability'. these are stories of courage rather than a genuine comment on the evidence in many cases. So if we are going to engage at a worldview level, it's not enough to offer rival evidence and data — you need to tell a different story. a story that is coherent, consistent, comprehensive, intellectually satisfying, liveable... and true.

The Christian story

As we outline the Christian worldview, we need to acknowledge that we will all recognise something (or someone) as the ultimate reality, the source of our existence. If you don't start with God, you will start with something else. this means there is no reason to shy away from starting with the Word of God as our source of authority, because everyone will base their worldview on a particular authority.

CREATION

God is revealed in the bible as a trinitarian god, quite distinct from the monistic gods of Islam or scientific atheism. the god of the bible gives order to the physical and human world. In genesis, god creates a formless world. the rest of the creation account (2) shows god ordering and filling the physical world (days 1 to 3 — order/form and days 4 to 6 — filling). finally, god gives human beings a commission to 'fill the earth and subdue it'. (3)

So the bible tells us that to be human is something of great dignity. as humans we derive our meaning from outside ourselves. We are made in the image of God (4) to continue his creative endeavour. We can therefore affirm the inherent goodness of work, civilisation, culture, farming, agriculture, politics, art, science... all are good and are from god as we order and fill the whole earth. However, God not only orders the physical world, but he also gives 'norms' by which he intends us to order the social world. If we do away with the creator, we lose any sense of his good norms, and we therefore diminish human beings. We no longer seek to conform our lives to this external reality, to revealed norms. Instead we bend reality to fit the norms that we create and personalise. It is a relatively recent phenomenon that society increasingly recognises no norms for sexuality or gender — it's all up for grabs.

A worldview starting with a trinitarian God also means there can be freedom. the three-in-oneness of the Godhead is the basis of the assertion that God is love. In love, there is freedom to choose and to be who we are made to be. This is a popular notion in our culture, and yet as those who are made in the image of God himself we cannot have our freedom and reject God's norms. The fence outside my house stops my little boy running onto the road; the freedom he enjoys in the garden depends on the fence keeping him safe. The point of God's laws and norms is that we enjoy the garden, that we can be all who we are made to be and are safe.

FALL

Our culture is not the first to discern and define its own norms without reference to the maker of reality. The biblical story continues in Genesis 3 where Adam and Eve rebel against God. We immediately see a fracturing of humankind's relationship with God. The intended relationship with God, made to be intimate, is now marked by hiding and fear. (5) We also see broken relationships with others and the earth itself. We see sibling relationships marred (6) and a progressive descent into revenge and violence. (7) and we see much of the fallout of this in the realm of healthcare.

Part of the fall is the exchanging of the creator for God substitutes, or what the bible calls 'idols'. Romans 1 is devastatingly revealing on this. We see that human beings have wilfully suppressed the truth (8) and they do not acknowledge God. Consequently, God has given them up to debased minds. (9) The Greek for 'mind' here is 'nous', which can be translated as 'worldview'. Instead of pursuing 'the mind [worldview] of Christ' (1 Corinthians 2:16), we naturally pursue our own worldview set up in rebellion to God. Paul doesn't let Christians off the hook. He goes on to say 'you... have no excuse' (Romans 2:1). In our culture we absorb ideas without realising it — we are susceptible to idolatry too. And as Romans progresses we see him urge them to be those who are transformed by the renewing of their minds; (10) their 'nous'; their worldview. (11)

Our worldview leads to beliefs that have implications for human value and purpose, our understanding of disease and death, morality, and much, much more. When we dehumanise people in our thinking, we will eventually mistreat, oppress, abuse and exploit them in our actions. When we don't see humans as bearing God's image, we imagine them otherwise and demean and diminish them. Idolatrous worldviews have consequences. that is why it is so important to identify them, otherwise we will miss the core issue.

REDEMPTION

In Paul's letter to the Colossians, after explaining that all things in creation are made by Christ, he states: 'for God was pleased to have all his fullness dwell in him, and through him to reconcile to himself all things, whether things on earth or things in heaven, by making peace through his blood, shed on the cross' (Colossians 1:19-20).

It is through faith in christ, in his perfect life, his death and subsequent resurrection, that we are 'reconciled' (12) and 'share in his inheritance'. (13) The chasm has been bridged and we can know right relationship with God again; we can indeed have the 'mind [worldview] of christ' and subdue and fill the earth rightly again.

If the fall is cosmic in nature, then so is redemption - the restoring of all that that has been misdirected by the fall. Christians are to be involved in the restoration of every area of life, discerning the structures God has given us and the good direction that these should go in. 'Imaging God' shouldn't be read just as a noun but also as a verb - it's what we do, which stems ultimately from our worldview. Our vocation is a way to pursue God himself - we are not just medics or nurses who happen to be Christians, but Christian medics and nurses in every area of life.

The Christian story starts with a garden and ends with a city coming down from the sky, (14) a city to which kings will bring 'the glory and the honour of the nations' (revelation 21:26). What a vote of confidence this is in God's creation and the role of humanity within it! It isn't that this world will be destroyed, but renewed. And so what we do now matters; how we treat others matters. And we won't know what to do, or how to treat others, if we don't know the story of which we are a part.

Getting practical

So what does this mean for us day to day? It means we must know our story and engage our minds...

1. With humility. We need to acknowledge common ground where we can affirm aspects of other worldviews. for example, we can affirm the rational mind because God created the world with a rationally knowable structure (Christ is the 'logos', the rational source of all things). (15) We should also admit where Christians have got things wrong and been triumphalist and insensitive.

2. In private. As medics we are at risk of becoming those who possess information without knowledge, opinions without principles and instincts without beliefs. If you are unthinking, you will be absorbed into the culture around you. You can explore this thinking gently with patients too - we are encouraged to 'take account of spiritual… factors' by the GMC. (16) Respectful probing might help reveal underlying reasons why people engage in certain risky behaviours, for example hopelessness or fear.

So ask people what they believe and understand it better than they do. Think deeply, be curious, don't get outthought by those with reductionist worldviews. Know the story you are a character in inside out.

3. In public. this will have huge implications for our medicine. Wider ethical issues at the moment include challenges around the making, the shaping and the faking of human life, for example reproductive technology and aI/robotics. The Christian story affirms that we are not just animals or machines but are dependent and made for relationship. And most strikingly, it claims to be the overarching story, total truth for all of life, both 'private' and 'public'.